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1.
Aust Health Rev ; 38(5): 580-3, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25283371

RESUMO

Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. WHAT IS KNOWN ABOUT THIS TOPIC?: Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. WHAT DOES THIS PAPER ADD?: Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services.


Assuntos
Reforma dos Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Satisfação no Emprego , Corpo Clínico/psicologia , Atenção Primária à Saúde/organização & administração , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Serviços de Saúde Rural , Vitória
2.
BMC Health Serv Res ; 12: 81, 2012 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-22448876

RESUMO

BACKGROUND: The ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable. METHODS: A 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS) located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure. RESULTS: Four years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified. CONCLUSIONS: This evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.


Assuntos
Eficiência Organizacional , Inovação Organizacional , Atenção Primária à Saúde , Garantia da Qualidade dos Cuidados de Saúde/métodos , Serviços de Saúde Rural/organização & administração , Fortalecimento Institucional , Relações Comunidade-Instituição , Assistência Integral à Saúde , Prestação Integrada de Cuidados de Saúde , Humanos , Liderança , Estudos Longitudinais , Modelos Organizacionais , Narração , Programas Nacionais de Saúde/organização & administração , Objetivos Organizacionais , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/ética , Atenção Primária à Saúde/normas , Vitória , Recursos Humanos
3.
BMC Health Serv Res ; 11: 52, 2011 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-21356123

RESUMO

BACKGROUND: Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. METHODS/DESIGN: The evaluation framework aims to examine the health service over a six-year period in terms of: (a) Structural domains (health service performance; sustainability; and quality of care); (b) Process domains (health service utilisation and satisfaction); and (c) Outcome domains (health behaviours, health outcomes and community viability). Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. DISCUSSION: This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how; what benefits have been realised and for whom; the level of community satisfaction with the service; and the impact of a health service on community viability. While the need to reduce the rural-urban health service disparity in Australia is pressing, the evidence regarding how to move forward is inadequate. This comprehensive evaluation will add significant new knowledge regarding the characteristics associated with a sustainable rural primary health care service.


Assuntos
Atenção Primária à Saúde/normas , Serviços de Saúde Rural/normas , Saúde da População Rural , Austrália , Coleta de Dados/métodos , Estudos de Avaliação como Assunto , Feminino , Administração de Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde
4.
Aust J Rural Health ; 18(4): 166-72, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20690913

RESUMO

OBJECTIVE: To develop a conceptual framework for monitoring the relationship between health services and health outcomes in rural Australia. DESIGN AND SETTING: Development of an evaluation framework for a rural comprehensive primary health service in Victoria. RESULTS: Evidence regarding essential components for successful primary health care, and objective health service and health status measures were combined to develop a conceptual health service evaluation framework. Application of the framework is illustrated using a case study of a rural primary health service in Victoria. CONCLUSIONS: Inadequate health services limit access to health care, delay use at times of need and result in poor health outcomes. Currently, there is a lack of evidence from rigorous health service evaluations to indicate which rural health services work well, where and why that could inform rural health policies and funding. Although the nature of health service models will vary across communities in order to meet their differing geographic circumstances, there is considerable scope for the translation and generalisation of evidence gained from health service models that are shown to be sustainable, responsive and able to deliver local quality health care. This framework can guide future health service evaluation research and thereby provide a better understanding of a health service's impact on the health of the community and its residents.


Assuntos
Serviços de Saúde Comunitária , Acessibilidade aos Serviços de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Atenção Primária à Saúde , Saúde da População Rural , Continuidade da Assistência ao Paciente , Humanos , Estudos de Casos Organizacionais , Vitória
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